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A season finale is a unique and delicate art form, something trickier to put together than solid series pilot. It needs to stand on its own as a great episode, but also deliver on the promise of a season's worth of storylines – a reward to the audience for sticking it out. It should keep the action true to the characters we've spent months learning to love (or hate), and plant the seeds for what lies ahead. The best, like MadMen's "Shut The Door, Have a Seat," from Season Three, or TheSopranos first season ender "I Dream of Jeannie Cusamano," or virtually any season finale of Breaking Bad (Hank on the toilet, Gale's face in the door, Lily of the Valley – take your pick), keep you talking and thinking and completely engaged until the show returns.

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If The Knick's inaugural dismount —“ Crutchfield" — doesn't quite hit all those notes, it certainly stays true to what Soderbergh and writers Amiel and Begler have tried to do in this premiere run. That is: create a world of flawed people with fucked up but noble ideas about scientific technology and man's place in it, spiced up with the gory minutia of turn-of-the-century medicine just for kicks. For all the drug addiction, secret trysts, busy fleas and underground fight clubs, this hospital's damaged crew of doctors, nurses and administrators showed up for work every day, and very often, did good, incredibly gross work. Cinemax renewed the series before the pilot aired, right after Soderbergh and crew completed shooting the season — and yet, "Crutchfield" feels like the creators were purposely setting the table for what's to come. The introduction of characters like Dr. Zinberg and Cornelia's brother, plus the feeling the writers held nothing back (Sister Harriet's secret identity revealed, Bertie discovering Lucy's affair, John Thackery's complete unraveling, the hospital's imminent closing), gives you the sense that they're blowing up all the big storylines so they can reset.

That said, it's hard to remember a season finale this bleak, in the sense that not one major character ends up in a better place than they started 10 episodes ago, and everyone across-the-board is miserable. Take Cornelia and Algernon. The "pretty, proper virgin on the cusp of your wedding day" seeks out the sister's services, only to regret it the moment she reunites with her lover. When the nuptials arrive, Algernon chooses to brawl with the biggest, baddest boxer he can find instead of heading to the church. The fight and the wedding is the big, wordless Soderberghian set piece of the hour; the two scenes, both staged in cavernous, vaulted spaces – one white, one dark – intercut to the voices of a choir in Godfather-esque fashion. She is a shell of the modern, progressive woman we've learned to know. He is a far cry from the proud, ego-driven Mr. Paris Shoes.

Then there's Herman, for whom the phrase, "Nothing breaks a man like a good cock punch," has never been more prophetic. After one of Bunky's goons delivers the aforementioned jab to the crotch, the hospital administrator hatches a plan to rid himself of the loan shark by enlisting Ping Wu to kill him, passing it off as fulfillment of a debt to Thackery. Whether the ensuing assassination sequence, also reminiscent of The Godfather, plays as accurate or ludicrous will be left for another time (to begin, google Sai Wing Mock), but there's no denying the entertainment value of a good ole chainmail n' hatchet action scene. Naturally, Herman being Herman, the whole escapade only makes things worse, since he's now indebted to a homicidal kung fu master.

But no one's reversal of fortune has been starker then Everett and Eleanor Gallinger, whose gruesome drama resolves with the latter's torture at the lunatic asylum. There are times when The Knick tilts into American Horror Storyterritory, and the casting of arch comic John Hodgeman as the physician didn't help dispel the sense that something was off – and not in a good way. That feeling continues when Everett attacks Algernon, blaming him for all his problems. It's a believable transference of anger – the man took his job and that's when everything started to go downhill. But the death of his child and his wife's subsequent spiral into madness played out so far removed from the rest of the hospital action, it seems odd Everett would cling to his misconception, when the audience (and seemingly, the writers) have long forgotten it.

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Sadly, a few favorite characters – Cleary, Harriet, Speight, Dr. Christianson's beard – were mostly or fully absent from this hour, and there was no mention of Nicaragua. But where "Crutchfield" succeeds, fittingly, is with the story of Dr. John Thackery. From the pilot's first shot of the out-of-it doctor waking in his opium den, The Knick promised a show about a brilliant but flawed anti-hero. As the season progressed, the series often undercut that notion by making others like Cornelia, Lucy and Algernon the focus. In the finale, however, Thackery again takes center stage. Firmly in the grip of a cocaine-and-Zinberg-induced paranoia, he mistakenly kills a patient and winds up completely incapacitated, with only the senior Dr. Chickering to save him. Bertie's full understanding of his mentor's dissolute habit, and more soul-squashing, the revelation of his affair with Lucy, gave the story extra bite. As they drive off after leaving Thackery in the sanitarium, their short, bitter exchange makes clear how far each traveled this season, and opens intriguing possibilities for where they could go next.

And then there's the near-perfect final shot of Thackery – now Crutchfield – left alone in his bed, framed by a loving close-up of his "medicine," the new wonder product from the Bayer Aspirin Company, named after the word "heroic." Foreshadowing for Season Two? We'll see.